One-on-One With NextGen President Pat Cline, Part I

Pat Cline says hospitals are leveraging Stark to underwrite ambulatory EHRs and “lock up the docs.”

Never before has the ambulatory EHR landscape been of such importance to the acute-care CIO. With the relaxation of Stark a few years ago, some savvy health systems began underwriting EMRs to independent practice in their areas. While HITECH threw the market a curve ball that temporarily slowed the Stark snowball, it has recently picked up apace. Most now realize that integrating with local physicians, and the guaranteed patient flow they constitute, is all-important to maintaining a robust market presence in the coming decades. To learn more about how HITECH and Stark are effecting ambulatory EHR vendors, HCI Editor-in-Chief Anthony Guerra caught up with NextGen Healthcare Information Systems President Pat Cline.

GUERRA: Overall, how has HITECH changed the market? Are we seeing the sales that people thought or is it still little slower than you anticipated at this point?

CLINE: I think it’s a little bit slower than everyone in our business anticipated. I think when the legislation was signed, it caused the opposite effect of what was intended. It was obviously designed to increase adoption and stimulate purchasing and implementation of electronic health record systems, but given that a lot of the definitions – for example, meaningful use and certification –weren’t clear, it had the effect of freezing or slowing down the marketplace.

But I think, through the summertime, as companies like NextGen Healthcare and many of our competitors educated or helped educate the marketplace, people got more comfortable that meaningful use, in fact, would be achievable, that the certification process wouldn’t be too far from the current certification process. Certainly, the criteria might be different, the standards or the procedures for certification might differ, but I think the market, asinformation has gotten disseminated, has gotten more comfortable.

So I think we’re seeing an increasingly robust market. I wouldn’t say it’s completely thawed,and I would say that there are still many practices waiting for clarity, but certainly – and more so on the high end – we see more activity. So I think the worst isbehind us and we’ll see, in my opinion, an increasingly robust market through 2010.

GUERRA: I’ve been a fairly outspoken critic of the legislation. What’s your take?

CLINE: Obviously, it’s a very, very complex issue and therefore the legislation needs a lot of detail. I think those that opened the box had no idea when they started what would ultimately be inside, though I do think that the details are important. So you couldn’t just start paying doctors for using electronic health record systems, for example, without defining what an electronic health record system is and what it should do and how it would be used, and so many other things. And we’re just starting to see a lot of related things, some of which have been addressed in the past, for example, privacyand security and how they’re to be dealt with, and things like tying these systems together, for example.

It’s one thing to say that, as far as meaningful use goes, systems will be interoperable, but what specifically does that mean, interoperable with what? Does that mean with patients, does that mean with other providers, does it mean with large health systems, does it mean the state health information exchange, the national health information network or some analog to it – and all of these things, as time goes on, have come up, and ultimately the marketplace and the providers need answers.

GUERRA: Even if HITECH solved the financing problem for providers, change management is still the hardest part, and not much has been done to help with that. It seems the regional extension centers won’t be running until it’s too late. What are your thoughts?

CLINE: First, that’s a terrific question. Both, in my opinion, are critical. You can’t get to the change management issue unless you can get past the financial issue. For many practices, especially the smaller practices, the financial barrier was too difficult for them to get past. I think when the financial barrier is knocked down, or becomes less of an impediment, acritical issue is the change management. Companies like NextGen, I think, have gone a long way to streamlineour implementation processes and do more heavy lifting for medical practices and make systems easier for them to use. We’ve made it easier for them to learn to use the systems by opening, for example, training centers across the country and delivering robust computer-based training and Internet-based training – all of those things are critical.

Hopefully, the regional extension centers will play a part, if that’s the way that we ultimatelygo, and I think many other third-party organizations will play a part. I think the biggest part of the job is to be done by the vendors and that is, again, making their system easy to implement and easy to use.

GUERRA: As a vendor, where do you draw the line between what you can do for a customer and what they must call in a consultant for?